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Morphology of psoas minor muscle--reviewed.

INTRODUCTION: Psoas minor is a slender muscle of posterior abdominal wall, having short fleshy belly and long tendon, lying anterior to Psoas major muscle. It is found to be absent in 40% individuals. It arises from the sides of bodies of T12 and L1 vertebrae and their intervening intervertebral disc. It is inserted by a long flat tendon attached to iliopectineal eminence, pectineal line and iliac fascia. It is innervated by ventral ramus of L1 spinal nerve. It is a weak flexor of trunk. (2)

It is well developed and constant in those animals who brachiate or run at very fast speed, where it is used to flex the pelvis on the trunk. (3, 4) It is active in cats when they arch their back. (5) In humans it has clinical significance in sports medicine, especially in football players (6) where the muscle often gets strained while playing with feet off the ground. Racial and morphological variations have been reported. (7) As quoted by Guerra et al. (2012) (8), in 1988 Gardener et al. (9) reported its insertion by a thin tendon, into iliopectineal eminence and arcuate line, inconstant insertion into iliac fascia and pectineal ligament. Further, Guerra et al. (2012) (8) have stated that according to Testut and Latarjet (1976) (10), it is not rare to find this muscle reduced to one or two tendons. Hence the present study has been undertaken to review the morphology of this vestigial, yet significant muscle.

MATERIALS & METHODS: 20 embalmed cadavers were used for the present study. Posterior abdominal wall muscles were exposed after removal of abdominal viscera. Presence of Psoas minor muscle was noted. The muscle was cleaned from its origin to insertion. Length and maximum width of its fleshy belly and tendon were measured with the help of digital vernier caliper, thread and scale. Observations were tabulated. Variations of Psoas minor muscle, if any, were noted and photographed.

OBSERVATIONS: In the present study, Psoas minor muscle was present in 40% (8/20 cases) cadavers studied: Bilateral in 35% (7/20 cases); & Unilateral in 5% (1/20 cases). Psoas accessorius (PA) was found to be present unilaterally in 15 % (3/20) cases.

The Muscle belly, in all the cases originated from the sides of bodies of T12 &L1 Vertebrae and the intervening intervertebral disc. Of these, in three muscle bellies (Fig. 1a) were bulky, where the origin extended to subdiaphragmatic fascia and medial arcuate ligament. Tendon, in all the cases, was long, flattened out at the insertion and blended with iliopsoas fascia; some aponeurotic fibres inserting over iliopectineal line (Fig.3a.). The Average length of fleshy belly was 7.85cm (Rt-7.56cm, Lt-8.14cm) and that of tendon was 13.13cm (Rt-13.56cm, Lt-12.7cm) (Table-1&2).The average maximum width of fleshy belly was1.93cm (Rt-1.96cm, Lt-2.14cm) and that of tendon was 0.77cm (Rt-0.76cm, Lt-0.78cm) (Table-1&2).

Wide variations were noted in the morphology of the muscle. Tendon in some cases was very thin (Fig.2b), while in few others it was broad (Fig.2a). The tendon lies close to genitofemoral nerve (Fig.3b), lying on the psoas major muscle. In one cadaver (Fig.3a.), the main tendon turned medially to merge with obturator fascia, while its shiny aponeurotic fibres were seen in fascia iliaca as well.

In one instance, on the left side, the main muscle is getting additional musculotendinous slips from the sides of bodies of L3, L4, L5 vertebrae. Psoas accessorius muscle was originating from the deep surface of left Psoas minor tendon to spread out as fleshy mass on anterior surface of Psoas major muscle (Fig.4c).

In two cases, it splits into a superficial layer which joins the deep surface of fascia iliaca as ribbon like bands. This superficial stratum could be gently dissected from the overlying fascia. The direction of superficial fibres is downwards and laterally forming an acute angle with the fibres of deep stratum. The deeper stratum runs on the anterior surface of Psoas major (Fig.4b) & both escape through the pelvifemoral space.

DISCUSSION: Gardener et al. (1988) (9), as reported by Guerra (8), stated that insertion of Psoas minor muscle is by a thin tendon into the iliopectineal eminence, arcuate line, the iliac fascia & pectineal ligament. In the present study, tendon, in all the cases, was long, flattened out at insertion and blended with iliopsoas fascia; some aponeurotic fibres inserting over iliopectineal line (Fig.3a.). Guerra et al. (2012) (8) have reported the presence of Psoas minor muscle in 13/22(59%), of which, in 4 fetuses Psoas minor tendon passed posteriorly to the crural arch & then into the pectineal line of femur. In the present study conducted on adult cadavers, it is found in 40%cases. Incidence of Psoas minor, found in present study, matches with that reported by Kendal et al. (11), & Wood jones et al. (12) (Table-4). In the same table, we can see that the incidence reported by Snell RS (13) is 60% & by Kraychete et al. (14) is 30% only. Thin Tendon of Psoas minor, may be mistaken for genitofemoral nerve. (15) In a study done by Saib (1934), which has been referred to by Hanson P et al. (1999) (7), Psoas minor muscle was reported to be present in 50% in Orientals, 43% in whites & 33% in blacks. Hanson P et al. (1999) (7) studied Psoas minor in blacks & whites, wherein it was found to be present in 2/21 (9%) in blacks & 87% in whites on both sides. In blacks, muscle appeared as slight thickening of fascia surrounding psoas major. In contrast, in whites, it was a well defined muscle anterior to & separate from Psoas major fascia.

Psoas minor is found to be consistently absent in those with Trisomy 18. Higher frequency of muscle anomalies in aneuploid is due to the delayed developmental processes in them. Muscles affected in them are generally those that differentiate rather late during embryonic development. (16) Psoas minor syndrome, which is caused by tense muscle & tendon, is attributed to its failure to keep pace with growth of pelvis. It leads to pain in corresponding iliac fossa, aggravated by palpation of taut tendon. Tenotomy gives relief. On right side, it needs to be differentiated from Appendicitis. (17) Psoas muscle strain occurs in athletes like professional Golfers & mostly in football players while playing with feet off the ground. It leads to pain in inguinal region extending towards the abdominal wall & testis, interfering with their ability to run, or jump. (6)

Reviewing the Literature, it is observed that, Joshi et al (2010) (1) reported the presence of Psoas accessorius in 25% cases, while in the present study it is found only in 15% cases. An interesting morphological variation observed was that the fibres of psoas accessorius arising from deep surface of tendon of psoas minor muscle split into a superficial & a deeper layer. The superficial lamina joined the deep surface of fascia iliaca as ribbon like bands. This superficial stratum could be gently dissected from the overlying fascia (Fig.4b.). The direction of superficial fibres was downwards and laterally forming an acute angle with the fibres of deeper stratum. The deeper stratum ran on the anterior surface of Psoas major & both the strata escaped through the pelvifemoral space. As described by Joshi et al. (2010) (1), Psoas accessorius continued on the superficial surface of the Psoas major muscle right upto its insertion. The muscle can be visualized by USG, CT & MRI. (18)

CONCLUSION: Present study, conducted in 20 cadavers, showed the presence of Psoas Minor muscle in 40% cases (8/20 cases): Bilateral in 35% (7/20 cases); & Unilateral in 5% (1/20 cases). Only 15% cadavers showed the presence of psoas accessorius unilaterally on the left side. In some cases it was present as superficial and deep lamina.

Inspite of being a regressive muscle, fleshy belly with a broad origin extending to subdiaphragmatic fascia & medial arcuate ligament was found in 15% cases. Wide variations at insertion were noted. Apart from its evolutionary significance, this muscle has clinical significance in sports medicine. (6)

REFERENCES:

(1.) Joshi S D, Joshi S S., Dandekar U K & Daimi S R; Morphology of Psoas minor & Psoas accessorius. J. Anat. Soc. India. (2010); 59(1) 31-34.

(2.) Standring S, Healy J C, Johnson D, Collins P, Crossman A R, Gatzoulis M A, Borley N R, Mahadevan V, Newell R LM, & Wigley C B; Grays Anatomy: The Anatomical Basis of Clinical Practice. 40thEdn. London Churchill Livingstone; 2008, pp 1072, 1368.

(3.) Woodburne RT; Essentials of Human Anatomy, 7th Edn. Oxford University Press, New York 1983, pp 465

(4.) Moore KL: Clinically oriented anatomy, 2nd Edn. Williams and Wilkins, Baltimore, London 1985, pp 275.

(5.) Hamilton W J; Textbook of Human Anatomy, 2nd Edn. English Language book society& Macmillan press Ltd. London & Basingstoke 1978, pp 149.

(6.) Kocho T V, Psoas minor strain In- Sports medicine & rehabilitation, International. Bradenton FL. (2004-2012).

(7.) Hanson P, Magnusson SP, Sorensen H and Simonsen EB; Anatomical differences in the Psoas muscles in young black and white men. J. Anat, 1999, 194 (2), pp 303-307.

(8.) Guerra. D.R.; Reis, F.P.; Bastos, A.A.; Brito, C.J.; Silva, R.J.S. & Aragao, J. A.: Anatomical study on the psoas minor muscle in human fetuses. IntJ.Morpho; (2012), 30 (1): 136-139.

(9.) Gardener, E.; Gray, D.J. & O'rahilly, R.O abdome. In: Gardener, E.; Gray, D.J. & O'Rahilly, R. Anatomia. Parede abdominal posterior. 4th ed. Rio de Janeiro, Guanabara Koogan, 1988. P.356.

(10.) Testut, L. & Latarjet, A. Musculos del abdomen: region posterior o lumboiliaca. Tratado de anatomia humana. 9th ed. Barcelona, Salvat, 1976. P.980.

(11.) Kendall FP, McCreary EK, Provance PG; Muscles testing And function, 4th Edn. Lippincott Williams and Wilkins, New York, London 1993, pp 214.

(12.) Wood Jones F; Buchanans Manual of Anatomy: in The Abdomen, 8th Edn. Bailliere, Tindall and Cox 7 and 8 Henrietta ST, W.C. London 1953, pp 841-842.

(13.) Snell RS; Clinical Anatomy by Regions, 8th Edn. Wolters Kluwer /Lippincott, Williams and Wilkins, Baltimore, New York 2008, pp 174, 175, 580.

(14.) Kraychete, D.C.; Rocha, A.P. & Castro, P.A. Psoas muscle abscess after epidural analgesia: case report. Rev. Bras. Anestesiol., 2007, 57, pp 195-198.

(15.) Basmajian JV, Slonecker CE; Grant's method of anatomy-A Clinical problem-solving approach, 11thEdn. Williams and Wilkins, Baltimore, London 1986, pp 197.

(16.) Stevenson R E, Hall J G; Human malformations & related anomalies, 2nd Edn. Oxford University Press, 2006; pp 801.

(17.) Travell JG, Simons D G; 1996; Myofascial pain & Dysfunction, 1st Edn.Vol.2, Chapter 5, pp 95.

(18.) Muttarak M, and Peh Wilfred C G; CT of unusual iliopsoas Compartment Lesions, Radiographics- The journal of Continuing medical education in radiology. 2000 Oct; 20 spec No: S53-66.

AUTHORS:

[1.] Sonali Agichani

[2.] Yogesh Sontakke

[3.] S.S. Joshi

[4.] S.D. Joshi

PARTICULARS OF CONTRIBUTORS:

[1.] Demonstrator, Department of Anatomy, Sri Aurobindo Institute of Medical Sciences & Post Graduate Institute.

[2.] Assistant Professor, Department of Anatomy, Sri Aurobindo Institute of Medical Sciences & Post Graduate Institute.

[3.] Professor & Head of Department, Department of Anatomy, Sri Aurobindo Institute of Medical Sciences & Post Graduate Institute.

[4.] Professor & Dean, Department of Anatomy, Sri Aurobindo Institute of Medical Sciences & Post Graduate Institute.

NAME ADRRESS EMAIL ID OF THE CORRESPONDING AUTHOR:

Dr. Sonali Agichani, 183, Kalani Nagar, Airport road, INDORE. Email-drsonaliagichani@gmail.com

Date of Submission: 17/07/2013.

Date of Peer Review: 18/07/2013.

Date of Acceptance: 29/07/2013.

Date of Publishing: 5/08/2013

Table (1)-Psoas minor (Right side).

Sr.       Length of      Width of            Tendon       Tendon
No.       Fleshy Belly   Fleshy belly (cm)   Length(cm)   Width(cm)
          (cm)

1         7              2                   14           0.5
2         8.5            2.5                 14.5         0.5
3         9              1.5                 13           0.8
4         5.5            1.8                 15           0.4
5         9              2                   16           0.8
6         7              2                   13           1.12
7         7              2                   11.5         1
8         7.5            2                   11.5         1
Average   7.56           1.72                13.56        0.76
Range     5.5-9          1.5-2.5             11.5-16      0.4-1.12

Table (2)-Psoas minor (left side).

Sr.       Length of      Width of       Tendon    Tendon
No.       Fleshy belly   Fleshy belly   Length    Width
          (cm)           (cm)           (cm)      (cm)

1          7               2              14        0.5
2          8               3.5            15.5      0.7
3         10               2.5            13        1.0
4          6               2              15        0.5
5          7               2               9        1.3
6         10               2              10        1
7          9               1              13        0.5
Average    8.14            2.14           12.7      0.78
Range      6-10          1-3.5          9-15.5    1-1.3

Table-3

Comparision of Right and Left Psoas Minor

        Length of    Width of       Tendon   Tendon width
Side    Fleshy       Fleshy belly   Length   (cm)
        Belly (cm)   (cm)           (cm)

Right   7.56         1.72           13.56    0.76
Left    8.14         2.14           12.7     0.78

Table-4

Reported incidence of psoas minor

S.N.   Researcher                Year   Incidence%

1      Kendal et. al (11)        1953   45
2      Wood jones et. al (12)    1993   40
3      Snell RS (13)             1999   60
4      Kraychete et. al (14)     2007   30
5      Joshi. et al (1)          2010   30
6      Guerra. D.R. et. al (8)   2012   59.09
7      Present                   2013   40
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Title Annotation:ORIGINAL ARTICLE
Author:Agichani, Sonali; Sontakke, Yogesh; Joshi, S.S.; Joshi, S.D.
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Report
Geographic Code:9INDI
Date:Aug 5, 2013
Words:2203
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